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03-102982 110 . • PP arr CONSTRUCTION PERMIT APPLICATION FEry 8 JUL - (_O 29 Z 2. -Qc. �.!I_. � ;;1101 APPLICATION NUMBER: APPLICATION NUMBER: CITY t =FE: 'E " WAY APPLICATION NUMBER: BUILDING DEPT, **The following is required information—Please print(in ink)or type** Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application. • PROPERTY INFORMATION SITE ADDRESS: ,St9 00 t 3,2 LID A-ye_ ASSESSOR'S TAX/PARCEL#: LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): FP (InC- ■ PROJECT INFORMATION TYPE OF PROJECT(This application): o BUILDING ❑ PLUMBING o MECHANICAL o DEMOLITION ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description): A-4D (1) � (( '1t f� P J (es ' FO PROJECT NAME: 51V 4W( G2P.(/ Iv Com- 1( • PEOPLE INFORMATION PROPERTY OWNER: NAME: DAYTIME PHONE: PO5f5 221)EV 2.LOPmakT ( r)k - )_ MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): Po ©ox °t'444q 52-fl-1T(-2 (OA °C8 Ia I CONTRACTOR: NAME: DAYTIME PHONE: ) MAILIN ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): 114 g.. C) EVENING PHONE: 8GQ Ti Pcv 2. . 5 O 11-Z [a km. I's 235 ( ) CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER: ( ) CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE: APPLICANT: NAME: DAYTIME PHONE: <P JL5(010 AV-A- LLQ- - -rb,u Y (3Tu L z rh41'9-- a c 6 MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): L1/4116310t.Db0.9 EVENING PHONE: N(civ 4 LOPPLA)©0.0 1j-u- OW.). t512.3 w ii- 4 V036 ( ) RELATIONSHIP TO PROJECT: 44. FAX NUMBER: 0 ARCHITECT ❑ TENANT k'OTHER(DESCRIBE):5t..,i1Cl7' Oae�C JtQ ( ) E-MAIL ADDRESS: CONTACT PERSON FOR THIS PROJECT: o PROPERTY OWNER KAPPLICANT o CONTRACTOR • DETAILED BUILDING INFORMATION EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION 4$1i, h PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ f I . 1 LO,("90 SPRINKLERED BUILDING? o YES o NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:o YES ❑ NO 1 ** IDENTIAL CONSTRUCTION ONL• 1111 NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $ . - ■ PROSECT FLOOR AREAS FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL BASEMENT - FIRST SECOND THIRD FOURTH OTHER FLOORS(DESCRIBE) DECK GARAGE HOW MANY FLOORS? TOTAL: Indicate number of each type of fixture MECHANICAL AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S) BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S) BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( ) COMPRESSOR(S) FURNACE(S) DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: 0 ELECTRIC ❑GAS PLUMBING BATHTUB(S) LAVATORY(S) URINALS) WATER HEATER(S) DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑GAS DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( ) INTERCEPTOR(S) SUMP(S) ■ DISCLAIMER/SIGNATURE BLOCK ' I certify under penalty of perjury that the Information furnished by me is true and correct to the best of my knowledge,and further,that I am authorized by the owner of the above premises to perform the work for which the permit application is made. I further agree to hold harmless the City of Federal Way as to any daim(induding costs,expenses,and attorneys'fees incurred in the Investigation and defense of such daim),which may be made by any person,induding the undersigned,and filed against the City of Federal Way,but only where such claim arises out of the reliance of the dty,induding Its officers and employees,upon the accuracy of the information supp . to the city a part of . is application. NAME/TITLE: L-�- .....00" /o .�. it.4/iU 1' - DATE: Y" /K*' (1 Cl PROPERTY OWNER ❑APPLICANT CONTRACTOR FOROFFICE:USE ONLY:. ._ x- . .._:;:. �� ;'O..NEW .;ADDITION t❑ALTERATION REPAIR,. = i7,t-TENANT-INiPROYEMENTF ,,�,._. .r , CENSUS`CODE I - ` .: -r ,� LOT "' ,.. *Pg. 0 ZONING DESIGNATION' 6 , _ ,.; . ; ,:.,. � ..,.. Y,. - ,; V� y_ �,.._, �.��..��-_ BUILDING SHELL ONLY7,,_v YES �;❑`NO .�_ _COMPPEANDESIGNATION g, ga "- 't. BASICPLANg "❑iYES'' ❑'NO,,i"` „ _,. ,,r . SECTION , x 1 -s ,�N, ._, ,: . .., ,. _.. , ._ TOWNSHIP��' RANGE .,: `��, _NEW ADDRESS.REQUIRE07, ,,7a-r❑YES �. d ANO PLATTED LOT? x YES ` ' "a 'CNANGE OF USE?, ,1„.,_- 13.YES -p NO r . COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129 www,cityoffederalway.com